Surveillance and deferred treatment for localized prostate cancer. Population based study in the National Prostate Cancer Register of Sweden.
OBJECTIVE
To what extent active surveillance and deferred treatment for localized risk prostate cancer are used is unclear. We assessed the use of surveillance and of deferred treatment in a population based, nationwide cohort in Sweden.


METHODS
In the National Prostate Cancer Register of Sweden, with a 98% coverage vs the compulsory Swedish Cancer Registry, we identified 8,304 incident cases of prostate cancer in 1997 to 2002 with age younger than 70 years, clinical local stage T1 or 2, N0 or Nx, M0 or Mx and serum prostate specific antigen less than 20 ng/ml. Data were extracted from medical charts for 7,782 of these men (94%) at a median of 4 years after diagnosis.


RESULTS
Primary treatment was surveillance for 2,065 men (26%), radical prostatectomy for 3,722 (48%), radiotherapy for 1,632 (21%) and hormonal treatment for 363 (5%). Men on surveillance had lower local tumor stage, grade and prostate specific antigen, and were older than those who received active primary treatment (p <0.001). After a median surveillance of 4 years 711 men (34%) on surveillance had received deferred treatment, which was radical prostatectomy for 279 (39%), radiotherapy for 212 (30%) and hormonal treatment for 220 (30%).


CONCLUSIONS
Surveillance was a common treatment for patients younger than 70 years with localized prostate cancer in Sweden in 1997 to 2002, 26% of men with localized prostate cancer started surveillance and after a median followup of 4 years, 66% of these men remained on surveillance.
Stattin
Pär
P
Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umea, Sweden. par.stattin@urologi.umu.se
Holmberg
Erik
E
Bratt
Ola
O
Adolfsson
Jan
J
Johansson
Jan-Erik
JE
Hugosson
Jonas
J
D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011471:Prostatic Neoplasms / Q000628:therapy*; D013548:Sweden; D013997:Time Factors